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https://www.readbyqxmd.com/read/28323324/preventing-hospitalization-with-veterans-affairs-home-based-primary-care-which-individuals-benefit-most
#1
Samuel T Edwards, Somnath Saha, Julia C Prentice, Steven D Pizer
OBJECTIVES: To examine how medical complexity modifies the relationship between enrollment in Department of Veterans Affairs (VA) home-based primary care (HBPC) and hospitalization for ambulatory care-sensitive conditions (ACSC) for veterans with diabetes mellitus and whether the effect of HBPC on hospitalizations varies according to clinical condition. DESIGN: Retrospective cohort study. SETTING: VA and non-VA hospitals. PARTICIPANTS: VA beneficiaries aged 67 and older with diabetes mellitus and enrolled in Medicare (N = 364,972)...
March 21, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28321136/procarbazine-lomustine-and-vincristine-pcv-regimen-for-central-nervous-system-tumors
#2
Dominic A Solimando, J Aubrey Waddell
The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr, President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, e-mail: OncRxSvc@comcast...
February 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/28318718/-treatment-of-macular-edema-comparison-of-efficacy-and-tolerability-of-subconjunctival-triamcinolone-injections-sub-tenon-s-triamcinolone-injections-and-intravitreal-dexamethasone-implant
#3
C Carbonnière, C Couret, A Blériot, O Lebreton, H Massé, G Le Meur, P Lebranchu, M Weber
The area of uveitis is related to numerous pathological entities. One of the main causes of decreased visual acuity in these patients is macular edema. One aspect of the treatment includes cortosteroids used peri- and intra-ocularly. MATERIALS AND METHODS: The goal of our work was to estimate the criteria of efficacy (on improvement in visual acuity and macular edema, as well as time to recurrence) and safety (on intraocular pressure and cataract) of these various routes of administration of corticosteroid after a single injection...
March 16, 2017: Journal Français D'ophtalmologie
https://www.readbyqxmd.com/read/28318620/factors-associated-with-mortality-risk-in-critical-care-patients-treated-with-veno-arterial-extracorporeal-membrane-oxygenation
#4
Sun Hee Lee, Dong-Soo Shin, Jong Ran Kim, Hyunjung Kim
OBJECTIVES: To identify factors associated with mortality in patients treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and to validate the discrimination of the risk assessment tools to predict mortality. BACKGROUND: VA-ECMO is a rescue therapy for patients with life-threatening cardiac failure, but mortality remains high. METHODS: In this retrospective study, we reviewed the medical records of adult patients who underwent VA-ECMO in an intensive care unit of a university hospital, between 2009 and 2013...
March 16, 2017: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/28295142/creation-of-an-interprofessional-teledementia-clinic-for-rural-veterans-preliminary-data
#5
Becky B Powers, Marcia C Homer, Natalia Morone, Natali Edmonds, Michelle I Rossi
The teledementia clinic is a new model of care that expands the reach of specialized geriatric and dementia care using clinical video telehealth (CVT) to rural veterans, who frequently lack access to specialty care. The clinic is a Veterans Affairs (VA) Geriatric Research, Education, and Clinical Center clinical demonstration project. It is located in the Pittsburgh VA Healthcare System tertiary referral hospital and serves veterans in affiliated rural community-based outpatient clinics (CBOCs). Rural CBOC primary care providers refer clinic patients, or referral is according to previous cognitive impairment diagnosis in a VAPHS geriatric clinic...
March 10, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28291673/mail-order-pharmacy-experience-of-veterans-living-with-aids-hiv
#6
Karishma Rohanraj Desai, Betty Chewning, Andrew Wilcox, Nasia Safdar
BACKGROUND: The VA system is the largest single provider of healthcare in the United States and to individuals infected with HIV specifically. High quality medication management is particularly important since HIV is a chronic infectious condition which requires taking multiple medications with strict requirements for adherence to medication regimens. Veterans Administration (VA) patients are required to obtain all chronic medications using the VA mail-order pharmacy system. OBJECTIVE: Drawing on Donabedian's Quality Improvement framework, this study sought to examine experiences that Veterans with HIV have with the Veterans Administration medication mail-order system, and to explore opportunities for quality improvement...
February 24, 2017: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/28289949/clinical-characteristics-of-optic-neuritis-in-hong-kong-population-10-year-review
#7
Bonnie Nga Kwan Choy, Alex Lap Ki Ng, Jimmy Shiu Ming Lai
PURPOSE: To review the clinical course of adult patients with acute optic neuritis over 10 years in Hong Kong, and the results were compared with other studies among Asian and Caucasian patients. METHODS: This study retrospectively analysed the clinical features of 38 adult patients (51 eyes) presented with optic neuritis in a Hong Kong hospital over 10 years (2001-2010). RESULTS: Optic neuritis had a female predominance (68%). The mean age of presentation was 40 years old...
March 13, 2017: International Ophthalmology
https://www.readbyqxmd.com/read/28288681/a-study-to-reduce-readmissions-after-surgery-in-the-veterans-health-administration-design-and-methodology
#8
Laurel A Copeland, Laura A Graham, Joshua S Richman, Amy K Rosen, Hillary J Mull, Edith A Burns, Jeff Whittle, Kamal M F Itani, Mary T Hawn
BACKGROUND: Hospital readmissions are associated with higher resource utilization and worse patient outcomes. Causes of unplanned readmission to the hospital are multiple with some being better targets for intervention than others. To understand risk factors for surgical readmission and their incremental contribution to current Veterans Health Administration (VA) surgical quality assessment, the study, Improving Surgical Quality: Readmission (ISQ-R), is being conducted to develop a readmission risk prediction tool, explore predisposing and enabling factors, and identify and rank reasons for readmission in terms of salience and mutability...
March 14, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28288076/impact-of-multisystem-health-care-on-readmission-and-follow-up-among-veterans-hospitalized-for-chronic-obstructive-pulmonary-disease
#9
Seppo T Rinne, Anashua R Elwy, Lori A Bastian, Edwin S Wong, Renda S Wiener, Chuan-Fen Liu
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the most common causes of readmission at Veterans Affairs (VA) hospitals. Previous studies demonstrate worse outcomes for veterans with multisystem health care, though the impact of non-VA care on COPD readmissions is unknown. OBJECTIVE: To examine the association of use of non-VA outpatient care with 30-day readmission and 30-day follow-up among veterans admitted to the VA for COPD. DESIGN: This is a retrospective cohort study using VA administrative data and Medicare claims...
March 10, 2017: Medical Care
https://www.readbyqxmd.com/read/28283421/association-of-provider-specialty-and-multi-disciplinary-care-with-hepatocellular-carcinoma-treatment-and-mortality
#10
Marina Serper, Tamar H Taddei, Rajni Mehta, Kathryn D'Addeo, Feng Dai, Ayse Aytaman, Michelle Baytarian, Rena Fox, Kristel Hunt, David S Goldberg, Adriana Valderrama, David E Kaplan
BACKGROUND & AIMS: Little is known about provider and health system factors that affect receipt of active therapy and outcomes of patients with hepatocellular carcinoma (HCC). We investigated patient, provider, and health system factors associated with receipt of active HCC therapy and overall survival. METHODS: We performed a national, retrospective cohort study of all patients diagnosed with HCC from January 1, 2008 through December 31, 2010 (n=3988) and followed through December 31 2014 who received care through the Veterans Administration (VA, 128 centers)...
March 7, 2017: Gastroenterology
https://www.readbyqxmd.com/read/28279729/access-to-post-hospitalization-acute-care-facilities-is-associated-with-payer-status-for-open-abdominal-aortic-repair-and-open-lower-extremity-revascularization-in-the-vascular-quality-initiative
#11
Jesus G Ulloa, Karen Woo, Chi-Hong Tseng, Melinda Maggard-Gibbons, David Rigberg
OBJECTIVE: Uninsured patients may not have access to post-acute care facilities that play an important role in clinical recovery and functional outcomes after vascular surgery. We sought to determine whether discharge disposition is associated with insurance status. METHODS: We retrospectively reviewed data from the Vascular Quality Initiative(®) for patients who underwent open abdominal aortic repair (OAR), infra-inguinal bypass (IB) or supra-inguinal bypass (SB) between January 2012 and July 2015...
March 6, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28275618/extracorporeal-life-support-for-refractory-ventricular-tachycardia
#12
REVIEW
Sujatha P Bhandary, Nicholas Joseph, James P Hofmann, Theodosios Saranteas, Thomas J Papadimos
Extracorporeal life support (ECLS) is a very effective bridging therapy in patients with refractory ventricular tachycardia (VT) associated with cardiogenic shock. A moribund patient in extremis, is not amenable to optimization by standard ACC/AHA guidelines. New approaches and novel salvage techniques are necessary to improve outcomes in patients with refractory clinical settings such as malignant ventricular arrhythmias, cardiac arrest, cardiogenic shock and/or pulmonary failure until further management options are explored...
February 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28266917/virtual-breakthrough-series-part-1-preventing-catheter-associated-urinary-tract-infection-and-hospital-acquired-pressure-ulcers-in-the-veterans-health-administration
#13
Lisa Zubkoff, Julia Neily, Beth J King, Mary Ellen Dellefield, Sarah Krein, Yinong Young-Xu, Shoshana Boar, Peter D Mills
BACKGROUND: In 2014 the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) implemented a Virtual Breakthrough Series (VBTS) collaborative to help VHA facilities prevent hospital-acquired conditions: catheter-associated urinary tract infection (CAUTI) and hospital-acquired pressure ulcers (HAPUs). METHODS: During the prework phase, participating facilities assembled a multidisciplinary team, assessed their current system for CAUTI or HAPU prevention, and examined baseline data to set improvement aims...
November 2016: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28264702/duration-of-veno-arterial-extracorporeal-life-support-va-ecmo-and-outcome-an-analysis-of-the-extracorporeal-life-support-organization-elso-registry
#14
Myles Smith, Alexander Vukomanovic, Daniel Brodie, Ravi Thiagarajan, Peter Rycus, Hergen Buscher
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is an effective rescue therapy for severe cardiorespiratory failure, but morbidity and mortality are high. We hypothesised that survival decreases with longer VA ECMO treatment. We examined the Extracorporeal Life Support Organization (ELSO) registry for a relationship between VA ECMO duration and in-hospital mortality, and covariates including indication for support. METHODS: All VA runs from the ELSO database from 2002 to 2012 were extracted...
March 6, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28259366/mechanical-support-with-venoarterial-extracorporeal-membrane-oxygenation-ecmo-va-short-term-and-long-term-prognosis-after-a-successful-weaning
#15
R García-Gigorro, E Renes-Carreño, J L Pérez-Vela, H Marín-Mateos, J Gutiérrez, M A Corrés-Peiretti, J F Delgado, E Pérez-de la Sota, J M Cortina-Romero, J C Montejo-González
OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) affords mechanical circulatory assistance associated to high mortality. However, weaning from such mechanical support may not imply improved short- or long-term survival. This study describes the characteristics and evolution of patients with refractory cardiogenic shock (RCS) subjected to venoarterial ECMO (VA-ECMO) in a hospital with a heart transplant program. DESIGN: A single-center, retrospective cohort study was carried out...
March 2, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28249028/heart-rate-variability-during-hemodialysis-is-an-indicator-for-long-term-vascular-access-survival-in-uremic-patients
#16
Ya-Ting Huang, Yu-Ming Chang, I-Ling Chen, Chuan-Lan Yang, Show-Chin Leu, Hung-Li Su, Jsun-Liang Kao, Shih-Ching Tsai, Rong-Na Jhen, Woung-Ru Tang, Chih-Chung Shiao
BACKGROUND: Vascular access (VA) is the lifeline of hemodialysis patients. Although the autonomic nervous system might be associated with VA failure (VAF), it has never been addressed in previous studies. This study aimed to evaluate the predictive values of the heart rate variability (HRV) indices for long-term VA outcomes. METHODS: This retrospective study was conducted using a prospectively established cohort enrolling 175 adult chronic hemodialysis patients (100 women, mean age 65...
2017: PloS One
https://www.readbyqxmd.com/read/28246571/avoiding-the-learning-curve-for-transcatheter-aortic-valve-replacement
#17
Sergey Gurevich, Ranjit John, Rosemary F Kelly, Ganesh Raveendran, Gregory Helmer, Demetris Yannopoulos, Timinder Biring, Brett Oestreich, Santiago Garcia
Objectives. To evaluate whether collaboration between existing and new transcatheter aortic valve replacement (TAVR) programs could help reduce the number of cases needed to achieve optimal efficiency. Background. There is a well-documented learning curve for achieving procedural efficiency and safety in TAVR procedures. Methods. A multidisciplinary collaboration was established between the Minneapolis VA Medical Center (new program) and the University of Minnesota (established program since 2012, n = 219) 1 year prior to launching the new program...
2017: Cardiology Research and Practice
https://www.readbyqxmd.com/read/28244947/intermediate-acting-nondepolarizing-neuromuscular-blocking-agents-and-risk-of-postoperative-30-day-morbidity-and-mortality-and-long-term-survival
#18
Michael R Bronsert, William G Henderson, Terri G Monk, Joshua S Richman, Jennifer D Nguyen, John T Sum-Ping, Michael P Mangione, Binh Higley, Karl E Hammermeister
BACKGROUND: Nondepolarizing neuromuscular blocking drugs (NNMBDs) are commonly used as an adjunct to general anesthesia. Residual blockade is common, but its potential adverse effects are incompletely known. This study was designed to assess the association between NNMBD use with or without neostigmine reversal and postoperative morbidity and mortality. METHODS: This is a retrospective observational study of 11,355 adult patients undergoing general anesthesia for noncardiac surgery at 5 Veterans Health Administration (VA) hospitals...
February 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28244496/a-comparison-of-the-rate-of-gastrointestinal-bleeding-in-patients-taking-non-vitamin-k-antagonist-oral-anticoagulants-or-warfarin
#19
David J Cangemi, Timothy Krill, Rick Weideman, Daisha J Cipher, Stuart J Spechler, Linda A Feagins
OBJECTIVES: Early reports suggested that the risk of gastrointestinal bleeding (GIB) was higher for patients on non-vitamin K antagonist oral anticoagulants (NOACs) than for those on warfarin. We compared the incidence of GIB in our patients on NOACs with those on warfarin. METHODS: We used our VA pharmacy database to identify patients taking NOACs (dabigatran, rivaroxaban, and apixaban) or warfarin between January 2011 and June 2015, and used the VistA system to identify those who were hospitalized for GIB...
February 28, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28237895/anticoagulation-practices-and-the-prevalence-of-major-bleeding-thromboembolic-events-and-mortality-in-venoarterial-extracorporeal-membrane-oxygenation-a-systematic-review-and-meta-analysis
#20
Eric Sy, Michael C Sklar, Laurence Lequier, Eddy Fan, Hussein D Kanji
PURPOSE: The purpose was to evaluate the safety of anticoagulation in venoarterial extracorporeal membrane oxygenation (VA-ECMO). DESIGN: We performed a systematic review and meta-analysis using multiple electronic databases. Studies were from 1977 to September 27, 2016. We evaluated the effect of anticoagulation in VA-ECMO on outcomes including major bleeding, thromboembolic events, and in-hospital mortality using a random effects model meta-analysis. RESULTS: Twenty-six studies (1496 patients) were included...
February 12, 2017: Journal of Critical Care
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